SIJ infiltration: targeted help for sacroiliac joint pain

What is the sacroiliac joint (SIJ)?

The SIJ connects the sacrum with the ilium and transmits forces between the trunk and legs. It is a tight joint with little mobility, stabilized by strong ligaments and surrounding muscles.

• Function: power transmission, shock absorption, pelvic ring stability
• Structures: articular surfaces, joint capsule, strong ligaments (including dorsal sacroiliac ligaments)
• Neighborhood: lumbar spine, hip joint, pelvic floor and gluteal muscles

Complaints: How you can recognize SI joint pain

Deep-seated pain next to the sacrum is typical, often on one side, radiating to the buttocks, groin or back of the thigh. The symptoms are often triggered by sitting for long periods of time, getting up, climbing stairs or standing for long periods of time.

• Stinging or dull pain next to the sacrum
• Pain provocation when turning in bed, putting on shoes
• Feeling of “blockage” or instability in the pelvis
• Radiation without real neurological deficits (tingling/numbness rare and mild)

Causes and risk factors

• Mechanical overload, imbalances, prolonged sitting
• Pelvic ring stress after pregnancy/birth
• Leg length differences, foot misalignments, gait changes
• Osteoarthritis/degenerative changes of the SI joint
• Consequence of lumbar spine problems or hip joint diseases (chain effect)
• Rare: Inflammatory rheumatic diseases, trauma

Diagnostics in our practice in Hamburg

We begin with a careful history and physical examination. Several combined provocation tests increase diagnostic accuracy. Imaging is primarily used to rule out other causes and plan therapy.

• Clinical tests: FABER (Patrick), Thigh Thrust, Gaenslen, compression/distraction tests
• Inspection of pelvic statics, gait, muscle tension
• Ultrasound for soft tissue assessment; X-ray/MRI if necessary
• Diagnostic block: short-acting local anesthetic into the SI joint - significant pain reduction suggests the SI joint as the source of pain

Conservative therapy first

Before infiltration, treatment is usually conservative. The aim is to relieve the SI joint, activate stabilizing muscles and reduce inflammatory irritations.

• Education, ergonomic adjustments, load control
• Physiotherapy: core stability, pelvic control, hip mobility
• Short-term anti-inflammatory medications (if tolerated)
• Targeted manual techniques and self-exercises
• Warmth/cold depending on the stimulus phase
• Optional tape/orthosis adjustment for a limited time

What is SIJ infiltration?

SIJ infiltration is the targeted injection of a local anesthetic, optionally in combination with a low-dose cortisone preparation, into the sacroiliac joint or into the surrounding painful ligament structures. It can be used diagnostically (test block) and therapeutically.

• Goal: Temporary pain relief and anti-inflammatory action
• Benefit: Confirmation of the source of pain, enabling active therapy
• Implementation: Image-guided under ultrasound or X-ray fluoroscopy

Process of ISG infiltration

The treatment usually lasts 10-20 minutes plus information. Usually no sedation is required.

Medications and variants

The standard is the combination of a local anesthetic (e.g. lidocaine) and, if appropriate, a low-dose corticosteroid. Alternatively, only local anesthetics can be injected periligamentally if a steroid-free strategy is desired.

• Diagnostic block: local anesthetic only, effect within minutes
• Therapeutic block: local anesthetic + low-dose cortisone
• Periligamentary infiltration: with ligament irritation/attachment tendinopathy
• Regenerative procedures (e.g. PRP) are examined individually and after careful information about evidence and costs; they are not standard.

Effectiveness and evidence

Studies show that sacroiliac joint infiltrations can reduce pain in the short term and make it easier to participate in physiotherapy in carefully selected patients. The duration of the effect varies: from days to several weeks or months. Infiltration is not a replacement for active therapy - it is most effective as a component in a multimodal, conservative concept.

• Diagnostic benefit: significant immediate relief suggests SIJ involvement
• Therapeutic benefit: often relevant but temporary pain relief
• Repetition: in selected cases 1-3 infiltrations at intervals of 2-6 weeks - only if there is benefit and no side effects

Risks, side effects and contraindications

SIJ infiltration is considered gentle, but – like any injection – carries risks. We clarify individually and take measures to minimize it.

• Common: temporary numbness/pressure, local pain at the injection site
• Uncommon: circulatory reactions, bruising, temporary worsening of symptoms
• Rare: infection, allergic reaction, vascular/nerve irritation
• Cortisone-related (when used): temporary increase in blood sugar, flushing, restlessness
• Contraindications: local infection, unexplained fever, severe coagulation disorder, recent anticoagulation (individual consultation), known allergies to components, pregnancy – relative assessment

Aftercare and behavior afterwards

• On the day of the infiltration, take it easy physically and do not drive a car yourself
• Cool if there is puncture pain, remove the plaster after a few hours
• From the following day: pain-adapted activation and physiotherapy
• 1-2 weeks of load control, avoiding strong provocative movements
• Documentation of the effect (pain diary) for therapy planning

Who is ISG infiltration suitable for?

The measure can be considered if there is increasing evidence of the SI joint as a relevant source of pain and basic conservative measures are not sufficiently effective.

• Typical sacroiliac joint pain with positive provocation tests
• Exclusion or co-assessment of lumbar spine/hip causes
• Severe irritation that hinders active therapy
• Desire for diagnostic clarification through a test block

Alternatives and combinable processes

Depending on the findings, other injection procedures, manual therapy approaches or procedures close to the nerves may be more useful. Surgical stiffening of the SI joint is reserved for rare, exceptional cases and is only discussed after consistent conservative therapy.

• Facet infiltration: for small vertebral joint pain in the lumbar spine
• Periradicular therapy (PRT) / nerve root injections: for radicular irritation
• Trigger point injections and neural therapy: for myofascial components
• Joint infiltrations on the hip/knee/shoulder: when other joints are involved
• Consistent physiotherapy, training and ergonomics program

Preparing for your appointment

• Please bring previous findings and imaging (X-ray/MRI) with you, if available
• List your medications, especially blood thinners
• Indication of allergies, desire to become pregnant or diabetes
• On the day of treatment, a light meal and comfortable clothing
• If possible, arrange for someone to accompany you on the way home

Your location in Hamburg

Our orthopedic practice is located at Dorotheenstraße 48, 22301 Hamburg. We value calm, careful implementation of image-guided infiltrations and individual follow-up care with clear exercises and training plans.